Organization
SALEM ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ZOE ANN WENDOLOWSKI RN (NURSE ADMINISTRATOR)
(503) 561-8170
Entity
Organization
Contact information
Practice address
875 OAK ST SE, SUITE 3095, SALEM, OR 97301-3975
(503) 561-8170
(503) 561-8167
Mailing address
875 OAK ST SE, SUITE 3095, SALEM, OR 97301-3975
(503) 561-8170
(503) 561-8167
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
071573
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005765
—
OR
01
—
102447500
REGENCE BCBS
OR
01
—
339145
PROVIDENCE
OR
01
—
P00280629
RAILROAD MEDICARE
OR
01
—
P356301
PACIFIC SOURCE
OR
Enumeration date
06/10/2006
Last updated
05/13/2014
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